Intralesional Injection of Candida Antigen 1/10 versus 1/1000 in the Treatment of Multiple Genital Warts: A Comparative study

Abstract

Genital warts (Condylomata acuminata, venereal warts, anal warts and anogenital warts) are highly contagious sexually transmitted disease caused by some sub-types of human papillomavirus (HPV). It is spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Warts are the most easily recognized symptom of genital HPV infection. They can be caused by strains 6, 11, 30, 42, 43, 44, 45, 51, 52 and 54 of HPV, but types 6 and 11 are responsible for 90% of genital warts cases. It is estimated that 1–2% of the sexually active population between the ages of 15 and 49 is afflicted with these HPV-associated verrucae. The treatment of warts poses a therapeutic challenge for physicians. No single therapy had been proven effective at achieving complete remission in every patient. As a result, many different approaches to wart therapy exist. These approaches include chemotherapy by (salicylic acid, TCA, podophyllin, podophyllotoxin), cryotherapy mostly by liquid nitrogen, electrosurgery (curettage and cautary), laser therapy and photodynamic therapy. All these previous destructive modalities may be painful, ineffective, costly, and may be associated with disfiguring scarring and high recurrence rates. There are new trends towards the use of immunotherapy in treatment of warts, as the immune system seems to play an important role in the control of warts infection. Although the exact mechanisms are unclear but most evidences suggest that cell mediated immunity plays an important role in control of HPV infection as the incidence of warts increases in subjects with cell mediated immune defects e.g (HIV infection patients, malignant diseases. etc….). Various methods have been used to stimulate the immunological response as oral levamisole, cimetidine, zinc sulfate, cidovir, intralesional interferons, topical imiquimod, intralesional immunotherapy with mumps, candida and trichophyton antigens, PPD Tuberculin antigen, BCG and Mycobacterium w vaccines. We aimed in this work to assess safety and effecacy of intralesional injection of candida antigen1/1000 versus 1/10 in the treatment of multiple genital warts. Our study was carried out on 60 female patients with 3 or more genital warts, referred from the Dermatology outpatient clinic of Ain Shams University Hospital. Complete history including age,marital status and complaint of the patients were obtained from the accompanying clinical sheets. General and local examination results were also obtained from the accompanying clinical sheets. The cases were categorized into three groups; group one included 20 patients who were treated with candida antigen 1/10, group two included 20 patients who were treated with candida antigen 1/1000 and group three is the control group of 20 patients who were injected with saline. As regards the response, group I 40 % showed complete clearance of injected warts only, 10 % gave partial response versus 50% showing no response with intralesional injection of candida antigen.